Neil Batrivala spent seven years building a healthcare company that serves a patient population that most in the tech industry have never heard of and that most in Silicon Valley ignore. But last month, that job put him at the center of something much bigger.
His company, Pear Team, announced on April 30 that it has been accepted into the Medicare program ACCESS as one of 150 participants selected by the Centers for Medicare and Medicaid Services to test what AI-driven healthcare could look like on a federal scale. The program will be broadcast live on July 5th.
“Governments are creating swim lanes for AI innovation in traditionally regulated industries,” he told me on a Zoom call a few days later. “The best solution wins, and that hasn’t been the case in a regulated industry like healthcare.”
ACCESS — Advancing Chronic Care with Effective, Scalable Solutions — is a 10-year CMS program testing payment models that reward health outcomes rather than required activities (such as a set number of check-ins). Participating organizations, such as Pair Team, receive predictable payments by controlling qualifying conditions and only receive the full amount if patients achieve measurable health goals, such as lower blood pressure or less pain. Diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety are covered.
This payment structure is real news.
Traditional Medicare reimburses you based on the time you spend with your clinician. There is no mechanism to pay an AI agent to monitor patients between visits, make check-in calls, coordinate housing referrals, or ensure they receive their medications. ACCESS was the first to create such a system.
“This is a transformation of the payment model,” Batrivala said. “I couldn’t do this before.”
The first cohort includes a wide range of participants, including AI physician startups, virtual nutrition therapy providers, connected device companies, and wearable manufacturers like Whoop. Butlibara is skeptical of some of them.
“I’m a big fan of wearables, but I don’t see how much Whoop can do for seniors who are struggling with food insecurity,” he said, adding that his company “has been building toward this for over five years.”
Pair Team was launched in 2019 with a specific type of patient in mind. These are people who are managing chronic illnesses while also dealing with unstable housing, too little food, and a lack of transportation. About one-third of Americans fit into that category.
The company’s premise was that you can’t improve someone’s health unless you address the entire situation in their life. It currently employs about 850 clinical professionals, operates what it calls the largest community health workforce in California, and generates revenues in excess of nine figures, according to Batlibala. Along the way, it raised about $30 million from Kleiner Perkins, Kraft Ventures, Next Ventures, and others.
This model is supported by peer-reviewed evidence. A study co-authored by Pair Team researchers and peer-reviewed in the Journal of General Internal Medicine evaluated Pair Team’s community-integrated model of medical, behavioral, and social care for Medicaid members with high rates of homelessness, serious mental illness, and chronic illness and showed strong patient engagement and significant reductions in avoidable emergency hospitalizations and inpatient utilization. Batrivara said one in four hospital visits and one in two emergency department visits would not occur if the patient was being treated at the office.
But for years, providing that level of care required a team of humans, which limited the ability to scale quickly and cheaply. Then, about nine months ago, the pair team introduced a voice AI agent called Flora as the primary patient-facing interface. Flora is available 24 hours a day, processing intakes, coordinating referrals, and checking in to keep patients engaged between appointments.
The first call that changed his mind was with a 67-year-old woman living in her car with PTSD and congestive heart failure. She talked to Flora for over an hour. “It was unbelievable and depressing,” Batlibara told me. “Flora was probably the only ‘person’ I talked to about my situation in the last few weeks.” Hour-long conversations with Flora are now routine. “That’s the work of the guys,” he said. “And it really turned out to be an intervention.”
The architect of ACCESS is also a former startup executive himself. The program was designed by Abe Sutton, director of the CMS Innovation Center, and Jacob Shiff, chief AI and technology officer for the CMS Innovation Center. Mr. Sutton was previously a venture capitalist at a healthcare fund called Rubicon Founders. Mr. Schiff is a former healthcare founder. Both men joined CMS under the Trump administration, and their startup backgrounds inform the program’s design, including performance-based payments, direct-to-consumer enrollment, and intentional pro-competition.
There are real risks. Participants are entering highly sensitive patient data, including intimate conversations about housing, illness, and mental illness, into federal infrastructure, along with a documented history of compromise, including compromised Social Security numbers. ACCESS is designed for vulnerable populations, and that is not an unrealistic concern.
There are also financial risks. The CMS Innovation Program has a mixed track record. A 2023 Congressional Budget Office analysis found that the CMS Innovation Center increased federal spending by $5.4 billion during its first 10 years, rather than generating the expected savings. CMS also paid less per patient per month than many participants expected. This means that this calculation will only work for organizations that have fully automated most of their patient interactions.
Batlibara’s answer to refund concerns is that it’s a feature, not a bug. “If you want to build a model that truly incentivizes the use of AI, you have to have low reimbursement rates,” he told me. “Economics only works if you run lean, AI-first operations.”
The pair are currently building a partnership that will give them access to around 500,000 potential patients, and say they hope to reach 1 million within three years.
Healthcare investors are watching all of this closely. Funding for digital health reached its highest first-quarter total since the pandemic this year, with AI companies capturing the bulk of it. On the other hand, ACCESS is hardly registered outside of the health tech industry press.
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